title: Is surveillance imaging effective for detecting surgically treatable recurrences in patients with melanoma? A comparative analysis of stage-specific surveillance strategies.
abstract: OBJECTIVE
  To guide resource utilization, we aimed to determine the impact of routine surveillance imaging for the detection of melanoma recurrences amenable to surgical resection with curative intent.
  
  
  BACKGROUND
  The National Comprehensive Cancer Network guidelines for melanoma surveillance are largely consensus based.
  
  
  METHODS
  Using single-institution, patient-level data (n = 1600), transition probabilities were calculated for a Markov model simulating the natural history of patients with stage I-III melanoma. As a base estimate, imaging was assumed to detect regional and distant recurrences of which 80% and 20% could be surgically treated with curative intent, respectively. Sensitivity analyses were conducted for all point estimates. For each disease stage, we calculated the number of surgically treatable regional or distant recurrence detected during 5 years per 10,000 patients undergoing computed tomography (CT) or positron emission tomography (PET)/CT scans at 6- or 12-month intervals. The associated positive and negative predictive values and life expectancy were also calculated and compared with clinical examination alone.
  
  
  RESULTS
  At 5-year follow-up, CT or PET/CT at 6-month intervals detected surgically treatable regional or distant recurrence in 6.4% of patients with stage I, 18.5% of stage II, and 33.1% of stage III disease; 12-month intervals decreased the rates to 3.0%, 7.9%, and 13.0%, respectively. The high false-positive rates of CT (20%) and PET/CT (9%) resulted in overall low positive predictive values. However, both CT and PET/CT effectively predicted absence of disease. Life-expectancy gains were minimal (≤ 2 months) for all groups.
  
  
  CONCLUSIONS
  The effectiveness of routine surveillance imaging for detecting treatable melanoma recurrences is limited. Even in patients with stage III disease, only minimal gains in life expectancy were achieved.
authors.affiliation: *Department of Surgical Oncology †Institute of Cancer Care Excellence ‡Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Natasha M
authors.initials: NM
authors.lastname: Rueth
authors.forename: Yan
authors.initials: Y
authors.lastname: Xing
authors.forename: Yi-Ju
authors.initials: YJ
authors.lastname: Chiang
authors.forename: Kate D
authors.initials: KD
authors.lastname: Cromwell
authors.forename: Merrick I
authors.initials: MI
authors.lastname: Ross
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Lee
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Gershenwald
authors.forename: Richard E
authors.initials: RE
authors.lastname: Royal
authors.forename: Janice N
authors.initials: JN
authors.lastname: Cormier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D062109:Dermatologic Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000601:surgery; D009367:Neoplasm Staging / Q000379:methods*; D049268:Positron-Emission Tomography / Q000379:methods*; D017410:Practice Guidelines as Topic; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018426:SEER Program / Q000592:standards*; D012878:Skin Neoplasms; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult; D000096142:Cutaneous Malignant Melanoma